Monthly Archives: March 2013

IN SPITE OF WHAT YOU MAY HAVE READ IN MY FAVORITE NEWSPAPER (the NY Times):

Chagas’ Disease, while being a medical nightmare, is not the new AIDS.

The first, and perhaps biggest problem with this article is calling Chagas’ Disease the “new” anything. Chagas’ disease was discovered in 1909 by a brilliant Brazilian scientist, Carlos Chagas. Chagas’ discovery was justly recognized for this great discovery during his own lifetime.

Chagas’ disease is like AIDS, in that it targets certain populations, but that is where the similarity stops. Chagas’ disease is spread by a vector (bugs of the family Reduviidae) that is exquisitely evolved to infect the poor, as it is related to low-quality housing. AIDS does target the poor of the world more than the rich, but there are certain groups that AIDS targeted, or continues to target, that have nothing to do with economic standing. AIDS is not transmitted by arthropod vectors (though there was concern in the early years of the pandemic), but by sexual contact and contaminated transfusions and medical equipment. Chagas’ disease can be spread by transfusion, but this risk is decreasing. As of a few years ago,around two decades after the blood supply began being screened for HIV, the blood supply in the US began being screened for Chagas’ disease.

Chagas’ disease is called a Neglected Tropical Disease. These are diseases that have high prevalence in the hotter regions of the globe, affect a large number of people but yet do not get a lot of attention from the press, their governments, NGOs, and even much of the local population. For example, many residents of Lima (where the power is) don’t even know what Chagas’ disease is, even though it afflicts a large number of Peruvians. Why? It doesn’t occur in Lima, and public education about the disease does not extend to those who won’t get it, even though they may be the ones most able to help.

Stigma: Yes, it sucks to get AIDS or Chagas’ or both together. But tell me from your heart of hearts: Which would you rather tell your co-workers and parents–that you’ve contracted HIV or that you’ve contracted Chagas’. I’m betting on Chagas’. 30 years into the epidemic, and HIV/AIDS still carries a burden unmatched by any other disease.

Research funding: No comparison. HIV/AIDS has been a research juggernaut over much of the pandemic. As a result, we’ve made brilliant and amazing progress in treatment and prevention of the disease. Chagas’ disease is still treated by the same two lousy drugs that were used over a decade ago. Some research is being done on new treatments, but I you’d be embarrassed to see the shoestring some of those labs run on. Moreover, most of these studies involve using drugs that were already approved for other indications, such as anti-fungals and anti-malarials.(They ain’t much money to make sellin’ drugs to po’ folk in the developin’ world.)

They were the sort of people who discussed the price of things at cocktails, exchanged market tips during dinner, and after dinner told dirty stories to mixed company. They did not belong to Neddy’s set—they were not even on Lucinda’s Christmas-card list. He went toward their pool with feelings of indifference, charity, and some unease, since it seemed to be getting dark and these were the longest days of the year. The party when he joined it was noisy and large. Grace Biswanger was the kind of hostess who asked the optometrist, the veterinarian, the real-estate dealer, and the dentist.

THAT’S WHY YOUR HEALTH INSURANCE DOESN’T COVER IT

ONE would think, to judge by the way health care insurance is provided, that the mouth is some separate entity, rather than the part of your body you probably use the most. Dental insurance, then, becomes like the rider to your homeowner’s insurance that covers your grandmother’s jewelry or your collection of stamps–it requires some sort of different coverage. I don’t know how the hell you’re supposed to eat, drink, kiss, or bite the fingers off of your predators without a mouth, but health insurance separates this one very important part of your body from everything else. It’s a historical anomaly, and one that should have been corrected when we let surgeons become doctors. If you haven’t noticed already, there’s a fair amount of pathology that can occur within the oral cavity, and much of it is related to illnesses elsewhere in the body.

Why doesn’t basic health care insurance cover problems to the teeth and gums? My primary care doctor’s exam of my mouth is brief and cursory. Would he be able to tell if I were unable to chew my food properly? Would he know where to look for the most common oral tumors?

I went to public health school at Boston University. They have a dental school. Were teeth or oral health even mentioned once during my time there? (That was a rhetorical question. No, of course, they were not. You would think that with the fluoridation of water being cited as one of the ten greatest public health measures of the 20th century that a light bulb might have gone off over someone’s head, but you would be wrong.)

Why am I thinking about all of this? Well, for one reason, I am now in the situation of shopping for dental insurance. Want to know what I’ve learned? Dental insurance sucks raw eggs. It eats donkey dung. It takes your premiums and then sneers at your pain. Worse than that, it doesn’t do enough for children who are going to need lots of care in order to get the smile that is required for getting a good job in this society.

Dentistry, as sufferers from dental problems know, does not come cheaply. According to thewealthydentist.com, a 2009 survey found the average root canal fee is $740 for a front tooth and $1,000 for a molar. Considering that the average dental insurance only pays around 60-70% for these procedures, the bill will come with an out-of-pocket expense of around $300. Benefits with most plans generally max out at around $1000-$1300 per year, and you can see that it’s going to take some serious jack if you’ve got more than an occasional problem.

Those of us who were lucky enough to grow up in financial security, along with parents who appreciated the fact that one is neither employable nor datable with a rotten mouth, can most likely survive with this insurance. It sensibly pays for two cleanings a year, helping the insurance company avoid having to pay out for more sever problems. But if you’re the person who grew up in where water wasn’t fluoridated, where you parents had rotten teeth, etc, you’re probably not in position to pay for all the work that needs to be done.

Enough, I said, of these civilities. It will be better that I should ask you a question: Is the physician, taken in that strict sense of which you are speaking, a healer of the sick or a maker of money? And remember that I am now speaking of the true physician. . .

Then medicine does not consider the interest of medicine, but the interest of the body?

Then, I continued, no physician, in so far as he is a physician, considers his own good in what he prescribes, but the good of his patient; for the true physician is also a ruler having the human body as a subject, and is not a mere money-maker; that has been admitted?

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An Online Journal of Chagas’ Disease, Rabies, Beverages from South America, Dishes from the Sixties, and Other Public Health Issues

If you wish to read the Chagas' Disease primer in order, click here to go to Part 1 and follow the links.
We do not wish to diminish the importance of Chagas' disease, or make it seem that we are equating its significance with that of Pisco Sours or Inca Kola--we realize, alas, that for the most part only geeks and do-gooders are interested in diseases like Chagas'. We are hoping that by including matters of interest to the general public that we may attract more readers.

Richard Lerner

Richard Lerner is the author of this blog. All complaints should be sent to anyone other than him. We are looking for other writers interested in vector-borne disease, or timely information on the fight against these conditions, especially in the Americas.